PDF(Pubmed)
Abstract：
OBJECTIVE: To clarify the mechanistic basis for the success or failure of noninvasive ventilation (NIV) in acute hypoxemic respiratory failure (AHRF).
METHODS: We created digital twins based on mechanistic computational models of individual patients with AHRF.
METHODS: Interdisciplinary Collaboration in Systems Medicine Research Network.
METHODS: We used individual patient data from 30 moderate-to-severe AHRF patients who had failed high-flow nasal cannula (HFNC) therapy and subsequently underwent a trial of NIV.
METHODS: Using the digital twins, we evaluated lung mechanics, quantified the separate contributions of external support and patient respiratory effort to lung injury indices, and investigated their relative impact on NIV success or failure.
RESULTS: In digital twins of patients who successfully completed/failed NIV, after 2 hours of the trial the mean (sd) of the change in total lung stress was -10.9 (6.2)/-0.35 (3.38) cm H2O, mechanical power -13.4 (12.2)/-1.0 (5.4) J/min, and total lung strain 0.02 (0.24)/0.16 (0.30). In the digital twins, positive end-expiratory pressure (PEEP) produced by HFNC was similar to that set during NIV. In digital twins of patients who failed NIV vs. those who succeeded, intrinsic PEEP was 3.5 (0.6) vs. 2.3 (0.8) cm H2O, inspiratory pressure support was 8.3 (5.9) vs. 22.3 (7.2) cm H2O, and tidal volume was 10.9 (1.2) vs. 9.4 (1.8) mL/kg. In digital twins, successful NIV increased respiratory system compliance +25.0 (16.4) mL/cm H2O, lowered inspiratory muscle pressure -9.7 (9.6) cm H2O, and reduced the contribution of patient spontaneous breathing to total driving pressure by 57.0%.
CONCLUSIONS: In digital twins of AHRF patients, successful NIV improved lung mechanics, lowering respiratory effort and indices associated with lung injury. NIV failed in patients for whom only low levels of positive inspiratory pressure support could be applied without risking patient self-inflicted lung injury due to excessive tidal volumes.
METHODS: We created digital twins based on mechanistic computational models of individual patients with AHRF.
METHODS: Interdisciplinary Collaboration in Systems Medicine Research Network.
METHODS: We used individual patient data from 30 moderate-to-severe AHRF patients who had failed high-flow nasal cannula (HFNC) therapy and subsequently underwent a trial of NIV.
METHODS: Using the digital twins, we evaluated lung mechanics, quantified the separate contributions of external support and patient respiratory effort to lung injury indices, and investigated their relative impact on NIV success or failure.
RESULTS: In digital twins of patients who successfully completed/failed NIV, after 2 hours of the trial the mean (sd) of the change in total lung stress was -10.9 (6.2)/-0.35 (3.38) cm H2O, mechanical power -13.4 (12.2)/-1.0 (5.4) J/min, and total lung strain 0.02 (0.24)/0.16 (0.30). In the digital twins, positive end-expiratory pressure (PEEP) produced by HFNC was similar to that set during NIV. In digital twins of patients who failed NIV vs. those who succeeded, intrinsic PEEP was 3.5 (0.6) vs. 2.3 (0.8) cm H2O, inspiratory pressure support was 8.3 (5.9) vs. 22.3 (7.2) cm H2O, and tidal volume was 10.9 (1.2) vs. 9.4 (1.8) mL/kg. In digital twins, successful NIV increased respiratory system compliance +25.0 (16.4) mL/cm H2O, lowered inspiratory muscle pressure -9.7 (9.6) cm H2O, and reduced the contribution of patient spontaneous breathing to total driving pressure by 57.0%.
CONCLUSIONS: In digital twins of AHRF patients, successful NIV improved lung mechanics, lowering respiratory effort and indices associated with lung injury. NIV failed in patients for whom only low levels of positive inspiratory pressure support could be applied without risking patient self-inflicted lung injury due to excessive tidal volumes.
摘要：
目的：阐明无创通气（NIV）治疗急性低氧性呼吸衰竭（AHRF）的成败机制。
方法：我们基于AHRF患者的机械计算模型创建了数字双胞胎。
方法：系统医学研究网络的跨学科合作。
方法：我们使用了30例中重度AHRF患者的个体数据，这些患者经高流量鼻插管（HFNC）治疗失败，随后接受了NIV试验。
方法：使用数字孪生，我们评估了肺力学，量化外部支持和患者呼吸努力对肺损伤指数的单独贡献，并调查了它们对NIV成功或失败的相对影响。
结果：在成功完成/失败的NIV患者的数字双胞胎中，试验2小时后，总肺应力变化的平均值（SD）为-10.9（6.2）/-0.35（3.38）cmH2O，机械动力-13.4(12.2)/-1.0(5.4)J/min,肺总应变0.02(0.24)/0.16(0.30)。在数字双胞胎中，HFNC产生的呼气末正压（PEEP）与NIV期间的设定相似。在NIV失败患者的数字双胞胎中，那些成功的人,固有PEEP为3.5（0.6）与2.3(0.8)cmH2O,吸气压力支持为8.3（5.9）vs.22.3(7.2)cmH2O,潮气量为10.9（1.2）vs.9.4(1.8)mL/kg。在数字双胞胎中，成功的NIV增加呼吸系统顺应性+25.0（16.4）毫升/厘米H2O，降低吸气肌肉压力-9.7（9.6）cmH2O，并将患者自主呼吸对总驱动压力的贡献降低了57.0%。
结论：在AHRF患者的数字双胞胎中，成功的NIV改善了肺力学，降低与肺损伤相关的呼吸努力和指数。NIV在只能应用低水平的正吸气压力支持的患者中失败，而不会因潮气量过多而导致患者自我造成肺损伤。
方法：我们基于AHRF患者的机械计算模型创建了数字双胞胎。
方法：系统医学研究网络的跨学科合作。
方法：我们使用了30例中重度AHRF患者的个体数据，这些患者经高流量鼻插管（HFNC）治疗失败，随后接受了NIV试验。
方法：使用数字孪生，我们评估了肺力学，量化外部支持和患者呼吸努力对肺损伤指数的单独贡献，并调查了它们对NIV成功或失败的相对影响。
结果：在成功完成/失败的NIV患者的数字双胞胎中，试验2小时后，总肺应力变化的平均值（SD）为-10.9（6.2）/-0.35（3.38）cmH2O，机械动力-13.4(12.2)/-1.0(5.4)J/min,肺总应变0.02(0.24)/0.16(0.30)。在数字双胞胎中，HFNC产生的呼气末正压（PEEP）与NIV期间的设定相似。在NIV失败患者的数字双胞胎中，那些成功的人,固有PEEP为3.5（0.6）与2.3(0.8)cmH2O,吸气压力支持为8.3（5.9）vs.22.3(7.2)cmH2O,潮气量为10.9（1.2）vs.9.4(1.8)mL/kg。在数字双胞胎中，成功的NIV增加呼吸系统顺应性+25.0（16.4）毫升/厘米H2O，降低吸气肌肉压力-9.7（9.6）cmH2O，并将患者自主呼吸对总驱动压力的贡献降低了57.0%。
结论：在AHRF患者的数字双胞胎中，成功的NIV改善了肺力学，降低与肺损伤相关的呼吸努力和指数。NIV在只能应用低水平的正吸气压力支持的患者中失败，而不会因潮气量过多而导致患者自我造成肺损伤。
